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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-7. Podiatric Services |
5160-7-04. Podiatric medicine: noncovered services
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(A) The following services are noncovered:
(1) All services exceeding the policies and limitations defined in Chapters 5160-4 and 5160-7 of the Administrative Code.
(2) Services determined by the department as not medically necessary as defined in Chapter 5160-1 of the Administrative Code.
(B) In addition, the following services are noncovered, unless an individual has a localized infection or is under the care of an eligible prescriber for a metabolic disease such as diabetes mellitus, or another condition that may result in a circulatory impairment or desensitization in the legs or feet:
(1) Examinations and diagnostic services associated with routine foot care performed in the absence of a localized illness, symptoms or injury;
(2) Cutting or removal of corns and calluses;
(3) Nail trimming, cutting or clipping of nails not associated with nail surgery, unless a systemic condition is present such as metabolic, neurologic, or peripheral vascular disease that may require scrupulous foot care by an eligible prescriber;
(4) Foot care provided for hygienic services;
(5) The treatment of uncomplicated, chronic foot conditions such as flat feet or a sublaxated structure in the foot; and
(6) Treatment of mycotic nails for an ambulatory and nonambulatory individual unless the eligible prescriber attending the patient's mycotic condition documents that:
(a) There is clinical evidence of onychomycosis of the toenail; and
(b) The individual has mycosis/dystrophy of the toenail causing secondary infection and/or pain that results or would result in marked limitation of ambulation and require the professional skills of a podiatrist podiatric physician.